Hallucinations Research Papers - Academia.edu (original) (raw)

A mildly chronological overview of the philosophers who may have been inspired by the use of psychoactive chemicals, inc. Plato, de Quincey, Davy, Schopenhauer, Nietzsche, James, Bergson, Benjamin, Jünger, Paz, Marcuse, Sartre, Foucault;... more

This is a collection of 500 contemporary fairy experiences: most from the English-speaking world. The pdf is 400 pages long: about 160,000 words. The experiences date from the 1920s to the 2010s and respondents were aged from three-years... more

This is a collection of 500 contemporary fairy experiences: most from the English-speaking world. The pdf is 400 pages long: about 160,000 words. The experiences date from the 1920s to the 2010s and respondents were aged from three-years old to ninety when they believe that they encountered fairies. It is hoped that the collection will allow for further studies of the supernatural and of supernatural experiences both by the editor and others. A second phase of collection is now underway.

Twenty patients with complex neuropsychologic symptoms associated with classic migraine were selected from a group of 200 patients with vascular headache. Twenty types of symptoms were found and grouped into six categories (language,... more

Twenty patients with complex neuropsychologic symptoms associated with classic migraine were selected from a group of 200 patients with vascular headache. Twenty types of symptoms were found and grouped into six categories (language, visual symptoms, cognitive-dysmnesic symptoms, olfactory-gustatory hallucinations, automatisms, and somatosensory symptoms). Some of the symptoms found have apparently not been reported previously. The importance of the analysis of this complex neuropsychologic set of symptoms and of the possible consequences of complicated, frequent vascular headache is emphasized. • Classic migraine, neuropsychologic symptoms

Auditory verbal hallucinations (AVH) are prevalent experiences that can induce distress and impede social functioning. While most voice hearers benefit from antipsychotic medication or cognitive-behavioural therapy, additional effective... more

Auditory verbal hallucinations (AVH) are prevalent experiences that can induce distress and impede social functioning. While most voice hearers benefit from antipsychotic medication or cognitive-behavioural therapy, additional effective interventions are needed to reduce the burden of experiencing AVH. 'Temstem' is an easily accessible and useable smartphone application that was developed by designers in close cooperation with voice hearers and experts. By using language games, Temstem aims to reduce distress and improve social functioning. This is a single-blind multicentre randomised controlled trial with two arms: 'Temstem+AVH monitoring' versus 'AVH monitoring' (total n=100). Participants are adult patients who suffer daily from AVH and will be recruited in outpatient units. Primary assessment in daily life is made by the Experience Sampling Method (ESM) and daily monitoring with the PsyMate app. During an ESM period of 6 days, participants assess their m...

Access the most recent version at doi: 1996 169: 148-159 The British Journal of Psychiatry PK McGuire, DA Silbersweig, I Wright, RM Murray, RS Frackowiak and CD Frith in schizophrenia: relationship to auditory verbal hallucinations The... more

Access the most recent version at doi: 1996 169: 148-159 The British Journal of Psychiatry PK McGuire, DA Silbersweig, I Wright, RM Murray, RS Frackowiak and CD Frith in schizophrenia: relationship to auditory verbal hallucinations The neural correlates of inner speech and auditory verbal imagery References http://bjp.rcpsych.org/cgi/content/abstract/169/2/148#otherarticles Article cited in: permissions Reprints/ permissions@rcpsych.ac.uk to To obtain reprints or permission to reproduce material from this paper, please write to this article at You can respond http://bjp.rcpsych.org/cgi/eletter-submit/169/2/148

Objective: To provide a systematic review of selected experimental studies of psychosocial treatments of behavioral disturbances in dementia. Psychosocial treatments are defined here as strategies derived from one of three psychologically... more

Objective: To provide a systematic review of selected experimental studies of psychosocial treatments of behavioral disturbances in dementia. Psychosocial treatments are defined here as strategies derived from one of three psychologically oriented paradigms (learning theory, unmet needs and altered stress thresholds).

AMPHETAMINE psychosis was first described by YOUNG and SCOVILLE in 1938.l Thereafter, sporadic reports of small series or single cases of amphetamine psychosis appeared in medical literature, but the condition was still considered to be... more

AMPHETAMINE psychosis was first described by YOUNG and SCOVILLE in 1938.l Thereafter, sporadic reports of small series or single cases of amphetamine psychosis appeared in medical literature, but the condition was still considered to be somewhat of a rarity. In 1958, CONNELL'S now classic monograph on the subject was published. In this study in which 42 patients with amphetamine psychosis were studied, CONNELL concluded that "Psychosis associated with amphetamine usage is much more frequent than would be expected from reports in the literature." Furthermore, CONNELL asserted that the clinical features of amphetamine psychosis might be such as to make it "indistinguishable from acute or chronic paranoid schizophrenia."2 This contention was not accepted without controversy. SLATER, reviewing CONNELL'S monograph, pointed out that amphetamine psychosis was characterized by a "brisk emotional reaction, usually in the direction of anxiety"3 whereas schizophrenia was not. BELL also compared the two conditions. IIe concluded that amphetamine psychosis was rather strikingly similar to schizophrenia in its presentation but that these two conditions could be differentiated by the presence of thought disorder which was prominent in schizophrenia and lacking in amphetamine psychosis.4 In 1968, GRIFFITH et al., undertook the first experimental induction of amphetamine psychosis in non-schizophrenic volunteer subjects within a controlled hospital environment." This enabled these workers to make observations on amphetamine psychosis in "pure culture", as it were, uncontaminated by the possibility of concomitant usage of other drugs or by schizophrenia that might have antedated amphetamine ingestion. GRIFFITH et al., administered 10 mg of dextro-amphetamine hourly for as long as was tolerated by their subjects and observed as an outcome, a generally abrupt onset of paranoid delusions, often with cold, detached affect. Their patient volunteers however, "did not exhibit a thought disorder or experience hallucinations". Other investigators had questioned whether anhedonia might constitute a distinction between amphetamine psychosis and schizophrenia.6 * lllhis work wils supported by USPHS Grant MH 04669.

Background: Factors such as poor insight, amotivation, suspiciousness, disorganized speech and attentional problems may interfere with the ability of acutely ill individuals with psychotic disorders to provide a valid account of their... more

Background: Factors such as poor insight, amotivation, suspiciousness, disorganized speech and attentional problems may interfere with the ability of acutely ill individuals with psychotic disorders to provide a valid account of their symptoms. This study was designed to determine the degree to which history provided by such subjects is consistent with that obtained from other sources. Method: Fifty-five subjects presenting with psychotic disorders were multiply evaluated with a semi structured interview, the Comprehensive Assessment of Symptoms and History (CASH), which includes the Scales for the Assessment of Negative and Positive symptoms (SANS and SAPS). One interviewer assessed the severity of the patient's symptoms in the previous month based solely on information provided by the patient. A second rater made symptom ratings based on information obtained from a ''best informant''. Following this, a consensus rating was established based on an extensive evaluation and review of all sources of information. An item-by-item comparison of the three sets of symptom ratings was then quantified by paired t-tests, simple and multiple correlations. Results: Positive and negative symptoms ratings based on the subjects' report were significantly lower than the corresponding consensus ratings. However, those based on the informants' report did not differ from consensus ratings for negative symptoms. Information obtained from subjects and from informants together accounted for a majority of the variance of the consensus ratings. Conclusions: These findings demonstrate that assessment limited to patients' own reports are likely to underestimate psychopathology in acutely ill patients with psychotic disorders. Obtaining corroborative history from a family member may substantially improve the validity of the assessment of negative symptoms. D

Background: a high prevalence of co-morbid mental health problems is reported among older adults admitted to general hospitals. Setting: an 1,800 bed teaching hospital. Design: consecutive general medical and trauma orthopaedic admissions... more

Background: a high prevalence of co-morbid mental health problems is reported among older adults admitted to general hospitals. Setting: an 1,800 bed teaching hospital. Design: consecutive general medical and trauma orthopaedic admissions aged 70 or older were screened for mental health problems. Those screening positive were invited to undergo further assessment, and were interviewed to complete a battery of health status measurements. Results: of 1,004 patients screened, 36% had no mental health problems or had anxiety alone. Of those screening positive 250 took part in the full study. Adjusting for the two-stage sampling design, 50% of admitted patients over 70 were cognitively impaired, 27% had delirium and 8-32% were depressed. Six percent had hallucinations, 8% delusions, 21% apathy and 9% agitation/aggression (of at least moderate severity). Of those with mental health problems, 47% were incontinent, 49% needed help with feeding and 44% needed major help to transfer. Interpretation: we confirm the high prevalence of mental health problems among older adults admitted to general hospitals. These patients have high levels of functional dependency, psychological and behavioural problems which have implications for how they are cared for. Services that identify these problems and offer therapeutic intervention should be evaluated.

Hallucinations have been recently associated with inhibitory deficits in memory. In this study, the authors investigated whether hallucinations were related to difficulties to inhibit irrelevant information from episodic memory... more

Hallucinations have been recently associated with inhibitory deficits in memory. In this study, the authors investigated whether hallucinations were related to difficulties to inhibit irrelevant information from episodic memory (Experiment 1) and working memory (Experiment 2). In Experiment 1, a directed forgetting task was used. This task measures participants' ability to intentionally forget some recently learned material, when instructions indicate that it is no longer relevant. In Experiment 2, an updating task was used. This task requires participants to intentionally suppress irrelevant information from working memory. Results showed that patients with schizophrenia with hallucinations presented inhibitory deficits in the directed forgetting task and an increase in the number of intrusions in the updating task, compared to patients without hallucinations and healthy controls. No correlations were found between indices of inhibition and other general, negative or positive symptoms. These findings support the existence of an association between intentional inhibition in memory and hallucinations, and they suggest that problems to suppress memory representations can underlie hallucinations in schizophrenia.

Background: Autoscopic phenomena are psychic illusory visual experiences consisting of the perception of the image of one's own body or face within space, either from an internal point of view, as in a mirror or from an external point of... more

Background: Autoscopic phenomena are psychic illusory visual experiences consisting of the perception of the image of one's own body or face within space, either from an internal point of view, as in a mirror or from an external point of view. Descriptions based on phenomenological criteria distinguish six types of autoscopic experiences: autoscopic hallucination, he-autoscopy or heautoscopic proper, feeling of a presence, out of body experience, negative and inner forms of autoscopy. Methods and results: We report a case of a patient with he-autoscopic seizures. EEG recordings during the autoscopic experience showed a right parietal epileptic focus. This finding confirms the involvement of the temporo-parietal junction in the abnormal body perception during autoscopic phenomena. We discuss and review previous literature on the topic, as different localization of cortical areas are reported suggesting that out of body experience is generated in the right hemisphere while he-autoscopy involves left hemisphere structures.

The Roman Circle of Psychopathology (Italy) This study is a preliminary theoretical discussion of possible specifi cities of AVHs (Auditory Verbal Hallucinations) in PTSD patients, based on the analysis of classic psychopathological... more

The Roman Circle of Psychopathology (Italy) This study is a preliminary theoretical discussion of possible specifi cities of AVHs (Auditory Verbal Hallucinations) in PTSD patients, based on the analysis of classic psychopathological literature enriched by personal clinical experience. AVHs have been extensively studied in empirical research, in diff erent clinical and non-clinical samples. Most of these studies do not show signifi cant diff erences, implicitly suggesting that AVHs are a unique "object" which is present in a wide array of clinical and non-clinical conditions. We claim that this is due to the instruments used to measure the phenomenon, and that a more qualitative study is needed to unveil possible diff erences. Accordingly, in this paper we focus on AVHs in persons with psychotraumatic reactions and, to highlight distinctions among apparently similar phenomena, we suggest considering AVHs not as fi xed, isolated object, but as the articulation of a dynamic, fi gure-background relationship. In patients with PTSD we found at least four diff erent kinds of AVHs: a) AVHs in typical post-traumatic fl ashbacks. In most cases of PTSD, AVHs appear within dissociative states of consciousness, such as fl ashbacks that represent one of the consequences of how the traumatic experience aff ects and modifi es the subject's experience. b) AVHs in post-traumatic fl ashbacks with "double-reality". AVHs, as well as other symptoms with a reliving character, can also be inscribed in brief experiences of dissociation such as depersonalization and derealization. c) AVHs in post-traumatic depression. AVHs are the external projection of the depressive guilt experienced by the patient. In these cases, AVHs are mood congruent, understandably derivable from guilt ideas, and represent the external personifi cation of what the patient thinks. d) "Schizophrenic-like" AVHs. AVHs occur in unaltered state of consciousness and they do not represent well-detailed personalities from the patient's past. Rather, they are vague, impersonal and allusive, as it is often the case with schizophrenic voices.

We report a case of recurrent psychosis, spanning decades, with full inter-episode recovery and minimal functional impairment. While it is difficult to classify this disorder using DSM IV-TR criteria, Leonhard and others have described a... more

We report a case of recurrent psychosis, spanning decades, with full inter-episode recovery and minimal functional impairment. While it is difficult to classify this disorder using DSM IV-TR criteria, Leonhard and others have described a 'cycloid psychosis' that correlates well with the phenomenology and course of this case. We believe this may represent a subset within the ICD-10 category of 'acute and transient psychotic disorders'. While this disorder, of unknown incidence, is not well reported in the U.S., it is worthy of further investigation and clinical attention given its generally favorable prognosis and potentially distinct pathophysiology and treatment.

Psychotic symptoms are a frequent occurrence in

Objective -To assess hallucinations in ParkinsonÕs disease (PD), we developed a novel practical rating scale that evaluates five items including variety, frequency, and severity of hallucinations, caregiver burden levels, and psychiatric... more

Objective -To assess hallucinations in ParkinsonÕs disease (PD), we developed a novel practical rating scale that evaluates five items including variety, frequency, and severity of hallucinations, caregiver burden levels, and psychiatric status at nighttime. Methods -Forty-one PD patients and their caregivers were examined regarding the status of the hallucinations associated with PD. Results -As a measure of internal consistency, the Tottori University Hallucination Rating Scale (TUHARS) has a CronbachÕs a of 0.88. Mini-Mental State Examination (MMSE) and Hoehn-Yahr stage were associated with the TUHARS scores in a multivariate regression analysis. Visual hallucinations are the most common. However, half of the patients who reported visual hallucinations also had other hallucinations. The scale scores in the PD patients with dementia (PDD) group were significantly greater than in the PD patients without dementia (PDnD) group. Conclusions -TUHARS appears to be a suitable and easily administered instrument for assessment of hallucinations in PD. PD patients experienced various kinds of hallucinations. Hallucinations may have a close relationship with cognitive decline in PD patients.

Objective: Repetitive transcranial magnetic stimulation (rTMS) to the temporoparietal region has been proposed as a therapeutic option for auditory verbal hallucinations (AVH). However, most large randomized controlled trials failed to... more

Objective: Repetitive transcranial magnetic stimulation (rTMS) to the temporoparietal region has been proposed as a therapeutic option for auditory verbal hallucinations (AVH). However, most large randomized controlled trials failed to demonstrate a superior effect of rTMS treatment as compared to sham. Previous studies applied daily rTMS sessions for one or more weeks to summate its effects. However, the effect of a single rTMS treatment on AVHseverity has never been studied, making it unclear if there is an initial effect that could be increased by repeated treatment.

Recent literature emphasizes that recovery from schizophrenia involves recovery within one's own narrative of an integral sense of identity, agency, social connection, and worth. While this is intuitively appealing and consistent with... more

Recent literature emphasizes that recovery from schizophrenia involves recovery within one's own narrative of an integral sense of identity, agency, social connection, and worth. While this is intuitively appealing and consistent with a wide range of literature, it raises the issue of how to best help people do this in individual psychotherapy. In this article, we explore how psychotherapy might help people construct new narratives or storied understandings of their lives and thereby promote recovery from schizophrenia. Exemplified with two individual examples, we first discuss the barriers that challenge and the techniques that help psychotherapists seeking to enter into dialogue with people with severe mental illness. We also offer a theoretical model of how the revitalization of dialogues within therapy can be conceptualized as a process that promotes recovery and discuss the objective measurement of such outcomes.

Objectives. Hearing voices groups (HVGs) are increasingly common in National Health Services and are often preferred to individual therapy by both service users and providers. Whilst a range of approaches exist, mixed results have been... more

Objectives. Hearing voices groups (HVGs) are increasingly common in National Health Services and are often preferred to individual therapy by both service users and providers. Whilst a range of approaches exist, mixed results have been found and only cognitive behaviour therapy (CBT) was supported by well-controlled trials. This study aimed to explore possible predictors and mechanisms of change in a seven-session CBT group for voice hearers.

Altered states of consciousness (ASC) can be represented in video games through appropriate use of sound and computer graphics. Our research seeks to establish systematic methods for simulating ASC using computer sound and graphics, to... more

Altered states of consciousness (ASC) can be represented in video games through appropriate use of sound and computer graphics. Our research seeks to establish systematic methods for simulating ASC using computer sound and graphics, to improve the realism of ASC representations in video game engines. Quake Delirium is a prototype ‘ASC Simulation’ that we have created by modifying the video game Quake. Through automation of various graphical parameters that represent the conscious state of the game character, hallucinatory ASC are represented. While the initial version of Quake Delirium utilised a pre-determined automation path to produce these changes, we propose that immersion may be improved by providing the user with a ‘passive’ method of control, using a brain-computer interface (BCI). In this initial trial, we explore the use of a consumer-grade electroencephalograph (EEG) headset for this purpose. Keywords—Altered States of Consciousness; Video Games; Brain-Computer Interface ...

The purpose of this study was to explore self-care management strategies for auditory hallucinations (AHs) among inpatients with schizophrenia. Self-report and semistructured questionnaires were used to identify 36 self-management... more

The purpose of this study was to explore self-care management strategies for auditory hallucinations (AHs) among inpatients with schizophrenia. Self-report and semistructured questionnaires were used to identify 36 self-management strategies of 200 inpatients with schizophrenia living at a veterans' hospital in Taiwan. The most commonly used management category was behavioral change and the most commonly used strategy was ignoring the AHs. The most common resource for strategies was selflearning. These results can help broaden health care providers' understanding about self-care management strategies for coping with AHs among inpatients with schizophrenia. Developing a manual containing selected self-care strategies and incorporating those strategies into cognitive-behavioral psychotherapy could be useful and beneficial to patients experiencing AHs. D

Background: Cocaine can induce transient psychotic symptoms. We examined the phenomenology of such cocaine-induced psychosis (CIP) using a modified version of the Scale for Assessment of Positive Symptoms (SAPS), a well-validated... more

Background: Cocaine can induce transient psychotic symptoms. We examined the phenomenology of such cocaine-induced psychosis (CIP) using a modified version of the Scale for Assessment of Positive Symptoms (SAPS), a well-validated instrument for the assessment of schizophrenic psychosis. Methods: We developed a new instrument, the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP), based on the well-validated SAPS. We interviewed 243 unrelated cocaine-dependent adults using both the SAPS-CIP and an instrument for the identification of cocaine-induced paranoia, the Cocaine Experience Questionnaire (CEQ). Results: One hundred and eighty-one (75%) of the subjects endorsed CIP using the CEQ. With the SAPS-CIP, hallucination (HAL) and delusion (DEL) scores correlated strongly, and the DEL domain showed excellent concurrent validity with the CEQ. We observed significant positive correlations, respectively, between severity of HAL and DEL, and lifetime number of episodes of cocaine use, and negative correlations with age at onset of cocaine use. Conclusions: The results suggest that CIP consists of transient delusional and hallucinatory symptoms, which tend to occur together and co-vary in severity. It appears that rating cocaine-induced paranoia alone (e.g., with the CEQ) can identify most subjects experiencing CIP. However, the SAPS-CIP is useful for quantifying the severity of CIP according to operational criteria. Our data provide additional evidence that CIP is a sensitizing response.

Corticosteroids are widely used in modern medicine but can result in troubling psychiatric side-effects. Physicians and other medical professionals should be aware of the potential for these side-effects, possible means of prevention, and... more

Corticosteroids are widely used in modern medicine but can result in troubling psychiatric side-effects. Physicians and other medical professionals should be aware of the potential for these side-effects, possible means of prevention, and efficacious treatments. Herein, we review adult case report data published during the past quarter-century on adverse corticosteroid-induced psychiatric effects, and present a case of corticosteroid-induced psychotic depression. PubMed and PsychLit databases were searched using the terms 'corticosteroids', 'steroids', and the generic names of corticosteroid medications with terms for psychiatric symptoms or syndromes, including psychosis, mania, hypomania, depression, apathy, anxiety, panic, depersonalization, delirium, confusion, hallucinations, delusions, paranoia, cognitive impairment and dementia. Fifty-five cases and a number of clinical trials investigating the incidence and treatment of these psychiatric symptoms and syndrome...

Lilliputian hallucinations have been described in patients with delirium, schizophrenia, seizure disorders, visual disturbances, and brain tumors. The authors report two cases of patients with lilliputian hallucinations, one with... more

Lilliputian hallucinations have been described in patients with delirium, schizophrenia, seizure disorders, visual disturbances, and brain tumors. The authors report two cases of patients with lilliputian hallucinations, one with AIDSdementia complex and the other with dementia following head trauma. This is the first time that lilliputian hallucinations have been described in association with such medical conditions.

Objective: To provide a systematic review of selected experimental studies of psychosocial treatments of behavioral disturbances in dementia. Psychosocial treatments are defined here as strategies derived from one of three psychologically... more

Objective: To provide a systematic review of selected experimental studies of psychosocial treatments of behavioral disturbances in dementia. Psychosocial treatments are defined here as strategies derived from one of three psychologically oriented paradigms (learning theory, unmet needs and altered stress thresholds).

Objectives. Auditory hallucinations are extremely distressing, particularly when occurring during adolescence. They may be most responsive to psychological intervention during a three-year critical period following symptom-onset, but as... more

Objectives. Auditory hallucinations are extremely distressing, particularly when occurring during adolescence. They may be most responsive to psychological intervention during a three-year critical period following symptom-onset, but as yet no studies have investigated voices groups for young participants with adolescent-onset psychosis. The aim of the current study is to explore the experience of group-CBT amongst a group of young people experiencing distressing auditory hallucinations.

Cognitive-behavioural therapy has been shown to be effective in reducing psychotic symptoms, but few patients have access to these services. Group cognitive treatment may provide a less costly service with similar benefits. To explore the... more

Cognitive-behavioural therapy has been shown to be effective in reducing psychotic symptoms, but few patients have access to these services. Group cognitive treatment may provide a less costly service with similar benefits. To explore the effectiveness of group cognitive-behavioural therapy on insight and symptoms, particularly auditory hallucinations. Twenty-one DSM-IV diagnosed patients with schizophrenia with treatment-resistant, distressing auditory hallucinations were referred to a group programme consisting of six sessions of cognitive treatment following a strict protocol which emphasised individual power and control as well as coping strategies. There were significant changes in all three main outcome measures following treatment; those changes were maintained at follow-up and were greater than changes over the waiting-list period. Specifically, there were changes in perceived power and distress as well as increases in the number and effectiveness of the coping strategies. Group treatment for auditory hallucinations needs further investigation but does look promising and may provide a less costly alternative to individual cognitive treatment.

This experiment examined the hypothesis that schizophrenics are less able than normals to make use of information concerning self movement when performing auditory localization tasks, and, therefore apply an alternative localization... more

This experiment examined the hypothesis that schizophrenics are less able than normals to make use of information concerning self movement when performing auditory localization tasks, and, therefore apply an alternative localization strategy, probably involving use of the pinnae. In this study three groups (healthy controls, schizophreniform patients and chronic schizophrenics) were compared in four experimental conditions:

Background/objectivesMany people with schizophrenia face stigmatisation. Several methods have been produced to simulate the auditory and visual hallucinations experienced by people with schizophrenia in order to increase empathy and... more

Background/objectivesMany people with schizophrenia face stigmatisation. Several methods have been produced to simulate the auditory and visual hallucinations experienced by people with schizophrenia in order to increase empathy and understanding about the condition. However, there has been no review of such methods. This systematic review aims to determine whether and how simulated hallucinations are effective in reducing stigma, and if

77115 paper reviews the contribution of natural history and genetic studies to the understanding of the syndrome called alcoholic hallucinosis. Critical analysis of research methodology demonstrates that the diversity of fundamental... more

77115 paper reviews the contribution of natural history and genetic studies to the understanding of the syndrome called alcoholic hallucinosis. Critical analysis of research methodology demonstrates that the diversity of fundamental definitions and assessment techniques challenge the interpretations derived from the data. Important questions for future research are outlined.

This article posits that the DSM-5 and its psychiatric diagnoses are a monumental artifact of social power rather than a useful system for naming, describing, classifying, or understanding mental disorders. Two biographic documentaries,... more

This article posits that the DSM-5 and its psychiatric diagnoses are a monumental artifact of social power rather than a useful system for naming, describing, classifying, or understanding mental disorders. Two biographic documentaries, Crumb and Jupiter's Wife, are examined as alternative information about people with severe mental, behavioral, and emotional disturbances, which ordinarily would be diagnosed as schizophrenia or a related psychotic disorder. In contrast to the disease processes implied by psychiatric diagnoses, these detailed documentaries revealed particular social (e.g., lack of positive role models, bullying), environmental (e.g., poverty, homelessness), and historical (e.g., child abuse, failure in school) factors that might have brought about the individual's personal problems. Seeing people in the actual places where they live and hearing about their struggles first-hand can evoke sympathy and empathy in viewers, potentially freeing them from the technical abstractions and pathological attributions inherent in psychiatric diagnoses.

Hallucinations are perceptual phenomena involved in many fields of pathology. Although clinically widely explored, studies in the general population of these phenomena are scant. This issue was investigated using representative samples of... more

Hallucinations are perceptual phenomena involved in many fields of pathology. Although clinically widely explored, studies in the general population of these phenomena are scant. This issue was investigated using representative samples of the non-institutionalized general population of the United Kingdom, Germany and Italy Ž . aged 15 years or over N s 13 057 . These surveys were conducted by telephone and explored mental disorders and Ž hallucinations visual, auditory, olfactory, haptic and gustatory hallucinations, out-of-body experiences, hypnagogic . Ž and hypnopompic hallucinations . Overall, 38.7% of the sample reported hallucinatory experiences 19.6% less than . once in a month; 6.4% monthly; 2.7% once a week; and 2.4% more than once a week . These hallucinations Ž . Ž . Ž occurred, 1 At sleep onset hypnagogic hallucinations 24.8% andror upon awakening hypnopompic hallucinations . 6.6% , without relationship to a specific pathology in more than half of the cases; frightening hallucinations were Ž . more often the expression of sleep or mental disorders such as narcolepsy, OSAS or anxiety disorders. 2 During the Ž . Ž . daytime and reported by 27% of the sample: visual prevalence of 3.2% and auditory 0.6% hallucinations were Ž strongly related to a psychotic pathology respective OR of 6.6 and 5.1 with a conservative estimate of the lifetime . Ž . prevalence of psychotic disorders in this sample of 0.5% ; and to anxiety respective OR of 5.0 and 9.1 . Haptic Ž . hallucinations were reported by 3.1% with current use of drugs as the highest risk factor ORs 9.8 . In conclusion, the prevalence of hallucinations in the general population is not negligible. Daytime visual and auditory hallucinations are associated with a greater risk of psychiatric disorders. The other daytime sensory hallucinations are more related to an organic or a toxic disorder. ᮊ M.M. Ohayon . 0165-1781r00r$ -see front matter ᮊ 2000 Elsevier Science Ireland Ltd. All rights reserved. Ž . PII: S 0 1 6 5 -1 7 8 1 0 0 0 0 2 2 7 -4 ( ) M.M. Ohayon r Psychiatry Research 97 2000 153᎐164 154

Ziconotide is a nonopioid analgesic currently indicated as monotherapy, but frequently used in combination with opioids, for the management of severe chronic pain in patients for whom intrathecal (IT) therapy is warranted and who are... more

Ziconotide is a nonopioid analgesic currently indicated as monotherapy, but frequently used in combination with opioids, for the management of severe chronic pain in patients for whom intrathecal (IT) therapy is warranted and who are intolerant of, or whose pain is, refractory to other treatments. There is a paucity of information regarding ziconotide use in patients with complex regional pain syndrome (CRPS). Seven cases in which IT ziconotide was used in patients with CRPS were analyzed. All patients (4 male, 3 female; age range, 14 to 52 years) had experienced inadequate pain relief with multiple conventional and interventional treatments. Three patients received ziconotide monotherapy exclusively; 4 patients received ziconotide monotherapy initially, then combination IT therapy. The mean ziconotide dose was 5.2 mcg/d (range, 0.5 to 13 mcg/d) at initiation and 24.7 mcg/d (range, 0.06 to 146 mcg/d) at the last available assessment. The mean duration of ziconotide therapy was 3.1 years (range, 26 days to 8 years). At ziconotide initiation, the mean visual analog scale (VAS) score was 89.3 mm (range, 75 to 100 mm); VAS scores decreased by a mean of 47.5% (range, 5% to 100%) at last assessment. Of the 5 patients who experienced substantial improvement in pain, edema, skin abnormalities, and/or mobility with ziconotide therapy, 2 have discontinued ziconotide and are pain free. Another patient experienced marked reversal of both edema and advanced skin trophic changes. Adverse events included urinary retention, depression, anxiety, and hallucinations. Adverse events generally resolved spontaneously, with treatment, or with ziconotide discontinuation/dose reduction. Although further studies are required, ziconotide holds promise as an effective treatment for CRPS.

In the Cartesian tradition, hallucination reveals that what we take to be direct experiences of the world are in fact mere appearances: appearances which give only mediate and unreliable testimony to reality. If hallucination can pass... more

In the Cartesian tradition, hallucination reveals that what we take to be direct experiences of the world are in fact mere appearances: appearances which give only mediate and unreliable testimony to reality. If hallucination can pass itself off as perception – if we can be deceived by hallucinations – then it is always possible that our perceptions are false. Thus, if we wish to have knowledge of the world, we must transition to a different register: that of reason and judgment. In this classical analysis, abnormal perception functions to show the deficit of normal perception. As is well known, Merleau-Ponty's analysis of hallucination differs from this classical analysis in crucial respects. Not only does Merleau-Ponty argue that hallucination differs structurally from perception and that the hallucinating subject does in fact distinguish between her hallucinations and her perceptions, but he uses his analysis of hallucination to confirm his account of the bond between perception and the world. It is Merleau-Ponty's analysis of hallucination that leads him to his first sustained account of perceptual faith in Phenomenology of Perception. Here, abnormality is conceived not as demonstrating the deficits of normal perception, but as confirming its claims. In this paper, I will try to show how this analysis is possible.

Visual hallucinations (VH) in Parkinson's disease (PD) are a chronic complication in 30 to 60% of treated patients and have a multifaceted phenomenology. Flickering, faultive impressions, and illusionary misperceptions precede the core... more

Visual hallucinations (VH) in Parkinson's disease (PD) are a chronic complication in 30 to 60% of treated patients and have a multifaceted phenomenology. Flickering, faultive impressions, and illusionary misperceptions precede the core syndrome of stereotyped, colorful images. The patient variably recognizes these images as hallucinations, being rarely irritated or frightened and more often amused as a bystander. Although studies on VH in PD focus on several research domains, no comprehensive, unified theory has been developed to study their pathophysiology. We have adapted Hobson's work on the states of consciousness and propose a model integrating seemingly disparate data on VH. We suggest that VH should be considered as a dysregulation of the gating and filtering of external perception and internal image production. Contributive elements and anatomical links for the model include poor primary vision, reduced activation of primary visual cortex, aberrant activation of associative visual and frontal cortex, lack of suppression or spontaneous emergence of internally generated imagery through the ponto-geniculo-occipital system, intrusion of rapid eye movement dreaming imagery into wakefulness, errative changes of the brainstem filtering capacities through fluctuating vigilance, and medication-related overactivation of mesolimbic systems. Different etiologies likely produce different phenomenologies and the prognosis may not be uniform. This new conceptual framework permits an anatomical view of VH and suggests new, testable hypotheses regarding their pathophysiology and therapy.

Clinicians need to consider a wide range of differential diagnoses when children and adolescents present with hallucinations. This includes considering whether it is a developmentally normal phenomenon or if there is a psychiatric,... more

Clinicians need to consider a wide range of differential diagnoses when children and adolescents present with hallucinations. This includes considering whether it is a developmentally normal phenomenon or if there is a psychiatric, medical, or neurologic diagnosis. Nonpsychotic children with hallucinations can be differentiated from psychotic children. Nonpsychotic children who are at risk (or prodromal) for future psychosis can be differentiated from nonprodromal healthier children. We examine the epidemiology, prognosis, and neurobiological research. Lastly, we discuss treatment approaches, including medication and cognitive behavioral therapy.